Provider Demographics
NPI:1902839905
Name:BATEMAN, CAMRON JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:CAMRON
Middle Name:JOHN
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12229 FLINTLOCK WAY
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-3473
Mailing Address - Country:US
Mailing Address - Phone:801-554-4286
Mailing Address - Fax:
Practice Address - Street 1:849 E 400 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2928
Practice Address - Country:US
Practice Address - Phone:801-328-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62232979934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1902839905Medicaid
UTP00400350OtherRAILROAD MEDICARE
UT1902839905Medicaid